Journal of Rehabilitation Medicine 51-4inkOmslag | Page 5

PRISMA 2009 Flow Diagram
Records identified through database
searching
(n =150)
Additional records identified
through other sources
(n = 0)
Records after duplicates removed
(n = 97)
239
variety of rehabilitation settings, detailed
thereafter (11–15). Largely, this evidence
demonstrates that NMES can reduce
oedema, although 1 study found no ef-
fect (15); however, the authors attribute
this to inter-group variance at baseline.
Other benefits of NMES within current
literature include improved quality of life
and reduced pain (11).
Chronic venous oedema/lymphedema. A
study by Bogachev et al. (11) on patients
(n = 30, limbs = 32) with chronic evening
Records screened
Records excluded
venous oedema found that total or partial
(n =97)
(n =75)
reduction of oedema occurred in 93.8%
of limbs with the use of NMES device.
Full-text articles excluded,
The circumference of the lower leg di-
Full-text articles assessed
with reasons
minished
by 20.3 mm (p < 0.001), pain
for eligibility
(n =15)
reduced
and
quality of life improved.
(n =22)
7 × oedema was not an
A more recent randomized clinical trial
outcome measure
5 × excluded intervention
(RCT) by Ravikumar et al. (12) assessed
2 × excluded device
the effect of footplate NMES in treating
Studies included in
1 × excluded study type
patients with venous disease (n = 22).
qualitative synthesis
(n =7)
Patients were treated with either NMES
or a sham device daily for 30 min over
a 6-week period. There was a significant
Fig. 1. PRISMA flow diagram.
difference in the percentage change in the
femoral vein flow parameters from base-
RESULTS
line between the treatment group and the
sham group whilst using the device. Limb volume was
A flow diagram of the study identification process is
observed to increase significantly in the sham group;
shown in Fig. 1 and a summary of the studies sourced
however, this was prevented in the treatment group,
is shown in Table III. Seven studies assessed the role
demonstrating that NMES can have a preventative role
of NMES for reducing oedema (11–17). Oedema size,
in orthostatic limb oedema.
or swelling, was a primary outcome measure in all the
A pilot interventional crossover study (n = 10)
included studies.
by Wou et al. (13) compared 2 NMES devices and
compression stockings for reducing lower limb oc-
Methodological quality of studies
cupational oedema in healthy individuals. Without an
Appendix 2 presents the results of the methodological
intervention, leg volume increased by a median of 41
assessment. Quality assessment scores ranged from
ml. All devices were well tolerated and reduced leg
56% to 88% (mean 77%). Reporting within the studies
swelling; however, there was no significant effect of
was generally consistent. Six studies scored the maxi-
NMES and the compression stockings were the only
mum attainable score for clearly describing the study
device that created a significant reduction in swelling.
aims and objectives (12–17). External validity was
Ankle sprain/fracture. A crossover, counterbalance
low scoring, generally due to study participants being
trial was completed by Man et al. (14) to evaluate the
selected patients, small study size and a lack of descrip-
effect of NMES on foot and ankle volume during 30
tion of the facility in which the study was undertaken.
min of standing (n = 20). A group of healthy patients
Internal validity was generally high scoring, with 5
completed 30 min of standing with and without
studies scoring maximum marks (12, 14–17). Marks
NMES applied to the gastrocnemius and the tibialis
were lost from 2 studies (11, 13) due to the absence of
anterior of the dominant leg, on 2 separate occasions.
reported patient compliance (item 19).
Mean volume changes from pre-test to post-test with
NMES and without NMES were significantly different
Summary of evidence
(p = 0.001). The authors concluded that the activation
Lower limb oedema. Five studies assessed the use of
of the musculo-venous pump by a NMES-induced
NMES for reducing oedema in the lower limbs in a
muscle contraction may reduce swelling in the lower
Effectiveness of NMES for reducing oedema: a systematic review
J Rehabil Med 51, 2019